Closure of a myelomeningocele should be based on an understanding of the altered anatomy. Reconstruction of the defect, including the form of the spinal cord, is dependent on this understanding. Assuming the exposed neural plaque is potentially functional tissue is the principle reason for preserving all neural tissue and for anatomical reconstruction of the spinal cord. Closure of the central canal of the spinal cord and suspension of neural tissue in a pia-arachnoid lined CSF compartment establishes a more normal microenvironment. It is hoped that this closure will prevent adhesion of neural elements to the closure and subsequent tethering of the spinal cord later in the child's life.